STAR+PLUS MMP Prior Authorization
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the Medicare Advantage provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
Vision services need to be verified by Envolve Vision
Dental Services need to be verified by DentaQuest
Complex imaging, CT, PET, MRA, MRI, and high tech radiology procedures need to be authorized by NIA
Behavioral Health/Substance Abuse need to be verified by Cenpatico
Are Services being performed in the Emergency Department, or Urgent Care Center, or are the services for dialysis or Hospice?
|Types of Services||YES||NO|
|Is a non-par provider rendering services other than lab, radiology or flu or pneumonia shots?|
|Is the member being admitted to an inpatient facility?|
|Are Anesthesia Services being requested for pain management or dental surgery?|
|Are services other than lab, radiology, domiclliary visits or DME being rendered in the home?|